AAN issues guideline on when people with Alzheimer's disease should stop driving

ST. PAUL, Minn. - The American Academy of Neurology has issued a new guideline to help determine when people with Alzheimer's disease or another type of dementia should stop driving. The guideline is published in the April 12, 2010, online issue of Neurology®, the medical journal of the American Academy of Neurology, and will be presented April 12, 2010, at the American Academy of Neurology's Annual Meeting in Toronto.

"While some people with dementia can still drive safely for a time, nearly all people with dementia will eventually have to give up driving," said lead guideline author Donald J. Iverson, MD, with the Humboldt Neurological Medical Group, Inc. in Eureka, Calif., and Fellow of the American Academy of Neurology. "It's important for doctors to discuss this with patients and caregivers soon after the diagnosis since restricted driving will affect the patient's quality of life and may lead to other health concerns such as depression."

The guideline recommends doctors use the Clinical Dementia Rating (CDR) scale to identify people with dementia at an increased risk of unsafe driving. The CDR provides a tool for clinicians to integrate information from caregivers and from direct examination of the patient to develop a comprehensive view of the dementia severity.

Evidence shows driving skills deteriorate with increasing dementia severity. "While patients with mild dementia, as a group, are higher-risk drivers, more recent studies report that as many as 76 percent are still able to pass an on-road driving test and can safely drive," said Iverson. "Faced with these facts, we needed to provide guidelines for doctors caring for these patients to identify those people at higher risk of unsafe driving, without unnecessarily restricting those who are safe drivers."

The guidelines also found that caregivers should trust their instincts. A study found that caregivers who rate a patient's driving as "marginal" or "unsafe" were often proven correct when the patient took an on-road driving test. On the other hand, patients who deemed their own driving as "safe" were not necessarily accurate in their own assessments.

Caregivers and family members play a role in identifying warning signs from unsafe drivers with dementia. These include:

Decreased miles being driven

Collisions

Moving violations

Avoiding certain driving situations, such as driving at night or in the rain

Aggressive or impulsive personality traits

"It is important that the decision to stop driving be directed by a doctor who is trained and experienced in working with people with dementia and their families," Iverson said. "Doctors should be aware that assessing driving ability is a complex process. More than one source of information is needed to make a judgment. In some situations, a dementia specialist may be needed."

Doctors, patients and caregivers must also know their state laws, since some states require that doctors report any medical conditions that may impact their ability to drive safely.

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The guideline is an update of the 2000 American Academy of Neurology guideline on driving with dementia.

The American Academy of Neurology, an association of more than 22,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer's disease, Parkinson's disease, ALS (Lou Gehrig's disease), multiple sclerosis, stroke and migraine. For more information about the American Academy of Neurology, visit http://www.aan.com.

Editor's Note:

Dr. Iverson will be available for media questions during a press conference at 11:00 a.m. ET, on Monday, April 12, 2010, in Room 803B of the Metro Toronto Convention Centre in Toronto. Please contact Rachel Seroka, rseroka@aan.com, to receive conference call information for those reporters covering the press conference off-site.

Dr. Iverson is available for advance interviews as well. Please contact Rachel Seroka, rseroka@aan.com, to schedule an advance interview.

To access non-late-breaking abstracts to be presented at the 2010 AAN Annual Meeting, visit http://www.aan.com/go/am10/science. Late-breaking abstracts will not be posted online in advance of the meeting and are embargoed until the date and time of presentation at the AAN Annual Meeting in Toronto or unless otherwise noted by the Academy's Media and Public Relations Department.

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